Healthcare Provider Details

I. General information

NPI: 1225157910
Provider Name (Legal Business Name): GREGORY & MAHANEY DENTISTRY PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3302 64TH ST
LUBBOCK TX
79413-5743
US

IV. Provider business mailing address

3302 64TH ST
LUBBOCK TX
79413-5743
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-4889
  • Fax: 806-793-2624
Mailing address:
  • Phone: 806-792-4889
  • Fax: 806-793-2624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10920
License Number StateTX

VIII. Authorized Official

Name: DAVID B GREGORY
Title or Position: PARTNER
Credential: D.D.S.
Phone: 806-792-4889